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Processed Amniotic Membrane Allografts Amniotic Membrane Allografts What Is Human Amniotic Membrane? • A unique, avascular membrane separating the mother from the fetus. • Provides an incubating environment promoting cellular differentiation. • Provides an immunological barrier to prevent “foreign body” rejection. Anatomical Profile: AM Anatomy of the Ocular Surface (1) Conjunctival Epithelium (2) Corneal Epithelium (6) Limbus – Stem Cells History of AM in Ophthalmology • • • • De Rotth. conjunctival defects (1940). Lavery. lime burn of conjunctiva and cornea (1946). Sorsby et al. caustic soda burns (1947). ALLOTRANSPLANTAT [late 80’s USSR->Venezuela, DR] • Batlle and Perdomo. Conjunctival substitute with placental allotransplant. Scientific Poster 25. American Academy of Ophthalmology meeting. Chicago, IL USA. October 1993. • Kim and Tseng. Transplantation of preserved human amniotic membrane for surface reconstruction in severely damaged rabbit corneas. Cornea 14:473-84, 1995. [ Surgical Indications: AM • • • • • • • Pterygium Excision Corneal Ulcerations/Perforations Chemical/Thermal Burns Bullous Keratopathy Ocular Dermoids/Tumors Fornix Reconstruction/Symblepharon Stem Cell Transplants Pterygium • A mutated growth on the surface of the eye • Requires surgical excision and placement of graft Corneal Ulcerations/perforations • A break or defect in corneal epithelium • Often secondary to other systemic diseases. Chemical/thermal Burns • Chemical burns often caused by alkali • Potentially devastating trauma to surface of the eye • Limbal graft possibly indicated Bullous Keratopathy • Edema of the corneal endothelium • Very common and usually affects individuals over 50 years of age. Dermoid/tumor Removal • Benign congenital tumors containing foreign tissue • Commonly found at the limbus Fornix Reconstruction • Fibrous tract that connects bulbar conj to conj of eyelid • Secondary to other acquired or traumatic conditions • Required reconstruction of ocular surface and eyelids Surgical Techniques: Amt/pterygium 2 Ambiodry Overview • • • • Tested & Safe Dehydrated Terminally Sterilized Strict, qualitycontrolled protocols • Device-like quality AmbioDry: Safe & Viable •Intact epithelial cell layer •Intact dense connective, basement membrane •Presence of loose fibroblast network AmbioDry: Logistical Features • Storage: Room-temp • No freezer required • No dry ice shipments • Simple prep: No soaks or rinses • IOP Customer Service: 24 Hrs/7 Days AmbioDry: Surgical Advantages • Substrate-free • Dry-state handling & trimming • Visual orientation identification • No tears or buttonholes • Device-like tissue quality AmbioDry Configurations • 1 x 2 cm • 2 x 3 cm • 4 x 4 cm Reimbursement Codes Supply code: V2790 CPT code: 65780 ocular surface reconstruction; Amniotic membrane transplantation AmbioDry & Tisseel The sutureless approach to eye surgery. Fibrin (biological) adhesive Eliminates sutures Reduces surgical time Improved patient care Better healing AmbioDry & Tisseel Video